AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION • Basic airway management and ventilation • The laryngeal mask airway and Combitube • Advanced techniques of airway management D2 • Basic mechanical ventilation Basic airway management and ventilation Objectives • Causes of airway obstruction • Recognition of airway obstruction • Basic techniques for airway management • Simple airway adjuncts • Simple devices to ventilate the patient’s lungs D3 Common causes of airway obstruction • Upper Airway – tongue – soft tissue oedema, foreign material – blood, vomit • Larynx – laryngospasm, foreign material • Lower Airway – secretions, oedema, blood – bronchospasm D4 – aspiration of gastric contents Recognition of airway obstruction • LOOK for chest/abdominal movement • LISTEN at mouth and nose for breath sounds, snoring, gurgling • FEEL at mouth and nose for expired D5 air Opening the airway • Head tilt • Chin lift • Jaw thrust • CAUTION! – cervical spine injury – But, death from hypoxia is more common than from injury to the D6 cervical spinal cord Head Tilt and Chin Lift D7 Jaw Thrust D8 Suction D9 Simple airway adjuncts D10 Sizing an oropharyngeal airway D11 Oropharyngeal airway insertion D12 Nasopharyngeal airway insertion D13 Mouth to mask ventilation Advantages: • Avoids direct person to person contact • Decreases potential for cross infection • Allows oxygen enrichment Limitations: • Maintenance of airtight seal • Gastric inflation D14 Bag-valve-mask, 2-person ventilation D15 Ventilation using self inflating bag Advantages Limitations • Avoids direct person to When used with a person contact facemask: • Allows oxygen • Risk of inadequate supplementation – up to ventilation 85% • Risk of gastric inflation • Can be used with • Need two persons for facemask, LMA, optimal use Combitube, tracheal tube D16 The Laryngeal Mask Airway and Combitube Objectives To understand: • The role of the LMA and Combitube during CPR D17 The Laryngeal Mask Airway Advantages Limitations • Rapidly and easily • No absolute inserted guarantee against • Variety of sizes aspiration • More efficient • Not suitable if very ventilation than high inflation facemask pressures needed • Avoids the need for • Unable to aspirate laryngoscopy airway D18 LMA Insertion D19 The Combitube Advantages Limitations • Rapidly and easily • Available in 2 sizes inserted only • Avoids need for • Potential for ventilation laryngoscopy via wrong lumen • Protects against • Damage to cuffs on aspiration insertion • Can be used if • Trauma on insertion inflation pressures • Single use D20 high Ventilation with the Combitube D21 Advanced techniques of airway management Objectives To understand: • The advantages and limitations of tracheal intubation during CPR • The technique of tracheal intubation • Methods for confirming correct placement of a tracheal tube • The role of needle cricothyroidotomy D22 Tracheal Intubation Advantages Limitations • Allows ventilation • Training and with up to 100% O2 experience essential • Isolates airway, • Failed insertion, preventing aspiration oesophageal • Allows aspiration of placement the airway • Potential to worsen • Alternative route for cervical cord or head injury D23 drug administration Tracheal Intubation Attempting intubation: • Pre-oxygenate the patient • Allow 30 seconds for attempt • Insert tube through larynx under direct vision • If in doubt or difficulty, re-oxygenate before further attempts Patients are harmed by failure of oxygenation, not failure of intubation! D24 Insertion of Tracheal Tube D25 Confirming correct placement of a tracheal tube • Direct visualisation at laryngoscopy • Auscultation: – Bilaterally, mid-axillary line – Over the epigastrium • Symmetrical movement of the chest during ventilation • Oesophageal detector device • Capnometry D26 Cricoid Pressure • Anteroposterior pressure on cricoid cartilage by an assistant to occlude the oesophagus against cervical vertebra D27 Cricoid Pressure Advantages Limitations • Reduces risk of • May make intubation regurgitation and more difficult aspiration • May impair • Useful during ventilation via intubation, facemask , LMA ventilation with • Avoid if active facemask or LMA vomiting D28 Needle Cricothyroidotomy Indication • Failure to provide an airway by any other means Complications • Malposition of cannula – Emphysema – Haemorrhage – Oesophageal perforation • Hypoventilation • Barotrauma D29 Any Questions? D30 .